I'm new here. Just need to vent about my CPAP experience

[eargos]

I'm new here so I'll give a quick background then on to my story (sorry about the length). I was diagnosed with sleep apnea 2 years ago and received a Respironics M Series Pro CPAP with C-Flex. At the time I wasn't really aware of different type/makes/models of machines and/or masks. The medical supplies company didn't even mention it. I just got what they gave me and that was that. Luckily, the machine I got turned out to be a good machine and I have been sleeping pretty well for 2 years until about 3 weeks ago when the humidifier died.

I tried using my machine without the humidifier and it was a huge failure. I live in a dessert so the pain/discomfort from CPAP without a humidifier is almost worse than no sleep at all. So, I started the process of getting a new machine (or so I hoped). My insurance had changed since I got the first one and the original medical supplies company would no-longer work with me for repair or replacement, so I went to the new supplies company and the first thing they did was ask for a prescription. The doctor that did my sleep study would not give me a prescription without a followup visit, and that visit would have been out of pocket due to being out of network on the new insurrance. Anyway, the people at the insurance company suggested I go to my general physician for a prescription, which I did.

Enter the next hurdle: The office staff at my general physician's office are 100% clueless when it comes to sleep apnea and CPAP treatment. I was told after my visit that they would send the prescription and orders to the supplies company and that I should wait to hear from them. I didn't hear anything after 3 days so I called to get the contact info for the supplies company they had supposedly sent my info to. It took me two days to extract that information from the highly competent staff at my physicians office, and when I finally did, I decided to drop in on the supplies company to get the ball rolling.

I went in and they told me they had no prescription on file, so I called the physicians office again, and they agreed to fax it over, again. I gave them the right fax number just in case and the guy at the supplies company told me they'd call the next day. Next day comes, no call... So I called them instead and they said they still never got the fax. I was still pretty calm at this point, but I was admittedly running out of patience. I decided to go pick up the prescription myself, and take it in to the supply co. in person.

I did get the prescription, but the office was busy and by the time I got out the supplies co was closed. Next day... I went in with the prescription and they told me it wasn't going to work the way it was written. Sooooooo, I went back to the physicians office and got a new prescription, written correctly, and returned with that in hand. Finally I got to talk to someone at the supplies co who was interested in helping me out. Yay! (or so I thought)

It turns out that the insurance company will not approve a new machine because the original is *only* 2 years old (never mind that it's broken after only 2 years), but they will send my machine in to be fixed, which will only take 2 weeks and cost about $100. This keeps getting better! Lucky for me, the medical supplies company will NOT give me a loaner machine since I didn't purchase the machine from them originally and am not purchasing from them now. But the real kicker is that my insurance is changing again at the end of that week due to a buyout at the company I work for, so not only is this a crappy offer from the insurance company, it's an offer I couldn't even accept if I wanted to! Perfect! I gave up at this point I figured my only option was to just wait for the new insurance to kick in and then see what they could do for me.

Fast forward a few more restless nights, and I call into the new ins. co. The first person I talk to has no idea what I'm talking about and transfers me to their prescription fulfillment dept. The perscription guy only knows that they don't handle equiptment so he's going to transfer me to another dept but drops the call instead O_o so I decided to go in to the local office (just a couple minutes away) and talk to someone in person. I get there and the receptionist immediately points me in the right direction and I sit down with some guy to talk about my dilemma. Anyone want to guess what he tells me next? They don't cover sleep apnea. At all! No consultations, no sleep studies, no equipment/parts/etc. Nothing! "to keep costs down" Well I'll be damned... that IS a great way to save money! just don't cover my medical condition, at all! It's genius! I guess my sleep apnea will just treat itself then? That wasn't all though... he did offer me this little gem of advice: "just look on ebay, people just sell them all the time because they don't really like them" to which I replied that I knew for a fact that ebay doesn't allow them because they can't legally be sold without a prescription. Still, he reassured me that "there are lots of them on ebay." Thanks!

After my meeting with the insurance guy I was feeling pretty hopeless. I'm under enough stress as it is without having to run around fetching prescriptions and beg insurance companies to help me out. I was on the verge of an emotional breakdown having come to the realization that I was basically left to my own devices to treat my sleep apnea. The story does have a good ending though... I went home and started checking online classified ads since i knew they were often sold via those "less-regulated" channels. I didn't expect to find anything newish and inexpensive (maybe one or the other), but within the hour I was the new owner of a lightly used Resmed S9 Auto with H5i humidifier, climateline hose, carry case, manuals, extra filters, used mask, etc. Total cost to me: 1 hour of my time and $400! It was a pretty big relief, and definitely a lucky find as there were others listed for ~$800 and this particular machine had been listed at $700 the day before. The seller just got antsy and wanted to go for the quick sell.

Anyway, I've got questions now about the new machine and how to best manage my own treatment (since I've really got no other option now) but I'll start another thread for my questions. I just wanted to share my experience and vent a little. If you read this whole post thanks for listening.

[Riorican]

Wow. You should sleep well the first night w s9 after all you went through to get it. You'll sleep well after that because you have a good machine. Your perseverance paid off. Good job!

[Pugsy]

Welcome to the forum. You have got a great machine.

Do you have the clinical manual for your machine? If not, do a forum search for member Uncle_Bob. He has link for the manual and software in his signature.

[robysue]

Welcome to the forum. And good luck on getting the supplies you need to continue treating your apnea. The filters and hoses probably won't be a problem, but getting the masks might be. If you have a prescription, then that should allow you to buy masks and mask parts on-line if you don't want grey-market items.

More seriously however, your tale is one of the best reasons I can think of about why the way we do health care in this country needs a thorough overhaul. You say:

and I sit down with some guy (from the new insurance company) to talk about my dilemma. Anyone want to guess what he tells me next? They don't cover sleep apnea. At all! No consultations, no sleep studies, no equipment/parts/etc. Nothing! "to keep costs down" Well I'll be damned... that IS a great way to save money! just don't cover my medical condition, at all! It's genius!

Talk about an insurance company being penny-wise and pound-foolish. Have they no idea what the real costs of untreated OSA are in terms of additional future medical expenses from conditions caused by or aggravated by untreated OSA?

[Janknitz]

and I sit down with some guy (from the new insurance company) to talk about my dilemma. Anyone want to guess what he tells me next? They don't cover sleep apnea. At all! No consultations, no sleep studies, no equipment/parts/etc. Nothing! "to keep costs down" Well I'll be damned... that IS a great way to save money! just don't cover my medical condition, at all! It's genius!

It is genius--you are much cheaper DEAD than alive

Seriously though, I'm not convinced what this guy told you was the truth. You need to see it in WRITING. What I highly recommend you do is request IN WRITING a copy of the "Evidence of Coverage" (EOC). This is the contract between you and your insurance company. Most states have laws that require the insurance company to give you a copy of the EOC upon request, and set a limit to how long the insurance company has to send it to you after you make a formal, written request (in California, it's 10 days). You do not get the EOC automatically when you sign up--it's something you have to specifically request.

Because the EOC is a contract, if it's in there, the insurance company has to follow it. But they are often ignorant of what's in your EOC (or lying) so you need to see it for yourself to be sure. What you want to look for is whether or not you have any DME (Durable Medical Equipment) coverage, and if so, whether there are any exclusions for CPAP equipment and supplies. If you don't have DME coverage, you are out of luck. But if you do have DME coverage, unless it specifically excludes CPAP equipment and supplies, you can enforce the contract and require them to pay according to the terms of the EOC. So make your written request ASAP to get the ball rolling.

[eargos]

It is genius--you are much cheaper DEAD than alive

Seriously though, I'm not convinced what this guy told you was the truth. You need to see it in WRITING. What I highly recommend you do is request IN WRITING a copy of the "Evidence of Coverage" (EOC). This is the contract between you and your insurance company. Most states have laws that require the insurance company to give you a copy of the EOC upon request, and set a limit to how long the insurance company has to send it to you after you make a formal, written request (in California, it's 10 days). You do not get the EOC automatically when you sign up--it's something you have to specifically request.

Because the EOC is a contract, if it's in there, the insurance company has to follow it. But they are often ignorant of what's in your EOC (or lying) so you need to see it for yourself to be sure. What you want to look for is whether or not you have any DME (Durable Medical Equipment) coverage, and if so, whether there are any exclusions for CPAP equipment and supplies. If you don't have DME coverage, you are out of luck. But if you do have DME coverage, unless it specifically excludes CPAP equipment and supplies, you can enforce the contract and require them to pay according to the terms of the EOC. So make your written request ASAP to get the ball rolling.

Thank you for this! I'm going to get to work on this right away.

[MikeS]

Sorry to hear about your story and I understand your frustration all too well. Sorry to be flippant but that is THE SYSTEM.

I was diagnosed with sleep apnea 6 years ago. After the initial sleep study the doctor reported to me in the proceeding appointment that I had one of the "worst cases of apnea he had ever seen"... with hundreds of these and thousands of those and gazillions of thats etc. I left the office with the feeling that I was really lucky to be still alive and not died of a heart attack or something else horrendous before then!

I did the titration and was prescribed a CPAP and asked where they should send the prescription to. "Well these are the places we deal with... a million miles away" But lucky me, there was one right next door! Well not really right next door... actually IN THE SAME OFFICE!!!!! Amazing! So I got my CPAP and it did help me sleep better. Every month I went in for the follow up visit that basically consisted filling out a 6 question questionnaire, discussing the answers with the doctor and sending the insurance company a bill. And every month I got new "Supplies" whether I needed them or not. And every month my insurance was billed for the supplies and they paid.

I was pretty embarrassed about having to use a machine to help me breathe at night... at first. After the first couple of years I became more open about it and more open about discussing my "Life threatening condition". The more I discussed my cpap the more I discovered other cpap users. I am in a small town and we all went to the same doctor. An amazing pattern started appearing, everyone that had gone to this doctor had sleep apnea. I found absolutely NO ONE that had ever heard of anyone that had gone to this doctor and NOT had sleep apnea. Amazingly enough everyone was getting there supplies from the same doctors office. The most AMAZING part about discussing sleep apnea with other CPAP users is THEY ALL HAD ONE OF THE WORST CASES OF SLEEP APNEA THE DOCTOR HAD EVER SEEN and they all FELT LUCKY TO BE ALIVE!!!!!

So who is the villain here? The insurance company? Or the doctor with a vacation house in Hawaii and a vacation Condo in the Virgin Islands?

My sister is a doctor and I have a lot of respect for her.... but I really get the feeling it is really just all about the money. So he is a member of the AMA and the AMA is the ones that make sure we are all kept safe from our selves by not being able to walk into a store or go to a website online and just buy a CPAP! Hmmm.....